Proton Therapy Cured His Throat Cancer; Now He's Back to Fishing

Fishing is one of Michael Rice’s passions. The now-retired commercial real estate broker, who has lived on Key Biscayne for 64 years, gets out on his boat for some offshore fishing once or twice a week, weather permitting. During summer’s tarpon season, he’s out once or twice a day.

Five years ago, however, at the age of 66, fishing was the furthest thing from Mr. Rice’s mind. He was diagnosed with throat cancer caused by the human papilloma virus (HPV). He had been experiencing some pain and swelling in his tonsils for a couple of months, he says, and he eventually went to see Michael Owens, M.D., an otolaryngologist with Baptist Health. Dr. Owens referred him to Noah Kalman, M.D., a radiation oncologist with Baptist Health Miami Cancer Institute.

What is Throat Cancer?

Throat cancer is a type of head and neck cancer, according to Dr. Kalman. “Head and neck cancers can appear in the tonsils, tongue and throughout the mouth, including the gums, roof of the mouth and cheek,” he says. “They also occur in the salivary glands, sinuses, the nose, the larynx (voice box) and the lower throat.” Caught early, however, many head and neck cancers are curable, Dr. Kalman adds.

Many types of throat cancer aren’t detected at first because early-stage signs are hard to identify. Over time, some throat cancer cells can spread (metastasize) to surrounding tissues, cartilage, bones or other parts of your body. Your treatment options and outcome will depend on your genetics, as well as the location and stage of your cancer.

According to the National Cancer Institute, head and neck cancers are diagnosed in about 67,000 people in the U.S. each year. An uptick in cases, particularly among younger adults, is attributed to the rise of the human papillomavirus (HPV). While the body fights off HPV infections, the effect of the virus on certain cells can lead to HPV-related cancers many years later, with some types of HPV more likely than others to lead to cancer.

The U.S. Centers for Disease Control and Prevention (CDC) estimates that roughly 42 million people in the United States are currently infected with HPV. About 13 million more people, including teenagers and adults, are diagnosed with HPV in the U.S. every year.

Treating Throat Cancer with Surgery and Radiation

Mr. Rice underwent surgery to remove his tumor and wanted his subsequent radiation treatment to be done at Miami Cancer Institute, which at the time had the region’s only proton therapy program. He met with Dr. Kalman, who told him that based on his tumor’s pathology, he would recommend proton therapy to reduce the risk of his cancer recurring. Five days a week for five weeks, Mr. Rice went to the Institute where high doses of radiation were precisely delivered to his tonsil bed as well as the side of his neck where his tumor had been.

“We treated only one side of the neck because Mr. Rice’s tumor was well-contained and his risk of contralateral involvement (having cancer in the other side of his throat) was low,” Dr. Kalman notes. “We used proton therapy for most of his treatment, which helped reduce doses to the adjacent salivary glands and tongue so patients have less dry mouth and taste issues long-term.”

During radiation treatment, Dr. Kalman explains, patients with head and neck cancers can experience tiredness; dry mouth; loss of taste; mucositis; trismus (difficulty opening the mouth); and skin irritation. Some of these conditions can persist after treatment, he adds.

According to Mr. Rice, his experience was smooth sailing. “I never stopped normal activity during treatment, and aside from the fried neck, I had no other side effects,” he says with a laugh, referring to the redness and irritation of the skin where his neck was treated, a common side effect of radiation therapy.

He credits his wife, Donna, a longtime nurse and educator, with helping him get through his cancer journey and being his patient advocate. “She’s been a nurse for more than 40 years, the last 15 as a professor at Barry University School of Nursing,” Mr. Rice says. “She knows stuff.”

Follow-Up Clinic Provides Cancer Monitoring and Support Services

Dr. Kalman reports that Mr. Rice “is doing great now” and his risk of recurrence at this point “is very, very low.” He says that Mr. Rice is one of the first patients of Miami Cancer Institute’s multi-disciplinary follow-up clinic.

“Here in the clinic, the radiation oncologist and cancer rehabilitation specialist see the patient together to both monitor for recurrence and help manage some of the musculoskeletal issues that can occur after radiation treatment,” explains Dr. Kalman. Patients in the follow-up clinic also receive nutrition, speech therapy, social work and other support services, he says.

Mr. Rice says he was pleased with his outcome – “Everything worked out as planned; there were no surprises” – and he would recommend Miami Cancer Institute to anyone. “They have all the latest stuff,” he says, referring to the fact that the Institute has every available radiation technology available today, all under one roof.

Common Symptoms of Throat Cancer

Symptoms of throat cancer can vary based on where the cancer starts. In its early stages, throat cancer can look and feel like the common cold or a regular sore throat. As the cancer develops, you can experience more or worsening symptoms. Talk with your doctor if you have:

• Bad breath
• Bleeding sores in your mouth
• Breathing changes
• Cough
• Difficulty swallowing
• Ear pain
• Facial pain
• Headaches
• Hearing changes
• Lumps or swelling in your mouth or neck
• Nasal blockages or obstructions
• Nosebleeds
• Sore throat
• Vocal changes

Risk Factors for Throat Cancer

Throat cancer can have significant impacts on your health and well-being. But, when it’s detected early, this cancer is highly treatable or preventable, says Dr. Kalman. And knowing your risk factors is important.

“While having risk factors doesn’t mean you will develop throat cancer, it will put you at an increased risk. Our specialists at Baptist Health Miami Cancer Institute can help you identify and understand the risk factors that are unique to you,” Dr. Kalman says.

The most common risk factors for throat cancer include:

• Alcohol use
• Asbestos exposure
• Being male (males are five times more likely to develop throat cancer than females)
• Being over age 65
• Chemical exposures (nickel, paint fumes, sulfuric acid)
• Ethnicity (being Black increases risk)
• Exposure to Epstein-Barr virus
• Exposure to human papillomavirus (HPV)

A Vaccine That Can Prevent Throat Cancers

Dr. Kalman says HPV-positive throat cancers such as Mr. Rice’s can be prevented with the HPV vaccine, which is recommended for children and young adults ages 9 through 26 and is offered to adults ages 27 through 45.

According to the CDC, the vaccine helps prevent many of the cancers caused by the virus, which is the most common sexually transmitted infection in the U.S. “Please get the HPV vaccine and put me out of business in 30 or 40 years,” pleads Dr. Kalman.

Noah Kalman, M.D., a radiation oncologist with Baptist Health Miami Cancer Institute

In addition to getting vaccinated against HPV-positive cancers, Dr. Kalman says that not smoking or drinking reduces the risk of HPV-negative throat cancers, those not caused by the virus. And, he stresses, don’t hesitate to get a suspicious lump on your neck checked. “If you have a neck mass, get evaluated by an ear, nose and throat specialist (ENT) or other provider,” he advises. “A painless neck mass is the most common presenting symptom for HPV-positive throat cancer.”

Grateful for His Successful Outcome

Mr. Rice, who Dr. Kalman describes as a “very warm person,” considers Dr. Kalman a “first-rate” physician. “Dr Kalman and his staff are always trying to make things better for their patients,” he says.

Now that he has recovered and summer is approaching, Mr. Rice is looking forward to plenty of tarpon fishing in the months to come. A master knot maker, too, Mr. Rice presented Dr. Kalman with one of his creative keychain knots as a token of his appreciation for his successful outcome. He also crafted the knot for the rope on the bell in Miami Cancer Institute’s lobby that patients ring to celebrate completion of their treatment.